Putting concordance for taking medicines into practice

When the medicines that doctors prescribe fail to produce the benefit they expect, they often respond by varying the dose or selecting an alternative medicine. Thus doctors seem to behave as though non-compliance is a problem for other doctors. Although we know that about half of the medicines prescribed for patients with long term conditions are not taken as prescribed,1 the concerns of health professionals have focused almost exclusively on improving the quality of their own prescribing choices. Similarly, attention and resources devoted by pharmaceutical companies to discovering, developing, and promoting new drugs utterly dwarf their efforts to see that medicines are taken by patients. Yet non-compliance continues to represent a serious therapeutic deficit at the core of medical practice, with consequent massive personal, societal, and economic cost.

Patients do not comply with medication for several reasons.2 Non-compliance may be intentional or involuntary. It may relate to the quality of information given, the impact of the regimen on daily life, the physical or ental incapacity of patients, or their …